Articles: intubation.
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Undiagnosed oesophageal intubation during anaesthesia is a major cause of anaesthetic-related morbidity and mortality. A test was devised and evaluated to distinguish between placing an endotracheal tube in the trachea and in the oesophagus. The test involves threading a lubricated nasogastric tube through the endotracheal tube, applying continuous suction to the nasogastric tube and then attempting to withdraw the nasogastric tube. ⋯ An evaluation was performed on twenty patients in whom both the trachea and oesophagus were intubated simultaneously. In all twenty cases, each of the two endotracheal tubes was correctly identified as being either tracheal or oesophageal. The ability to maintain suction and the ease of withdrawal most clearly distinguished between the two positions.
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Ann Oto Rhinol Laryn · Feb 1989
Model of a new generation of tracheostomy and endotracheal tubes. A preliminary study of sensors to monitor obstruction.
The feasibility of monitoring cannula obstruction was studied by conversion of the electrical resistance of substances that are capable of causing obstruction into audible auditory signals. Copper-nickel-gold electrodes were thermal pressed onto polyimide-based flexible films placed as 1-mm wide strips along the inner surface of tracheostomy and endotracheal tubes. ⋯ Quantitative estimates of responses from the IC output were computer averaged. Instantaneous obstruction detection was made possible by the immediate responsiveness of the device in the presence of obstruction.
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Acta Anaesthesiol Scand · Feb 1989
Comparative StudyEarly detection of inadvertent oesophageal intubation: pulse oximetry vs. capnography.
The aim of our retrospective study was to evaluate the efficacy of routine pulse oximetry and capnometry for detection of oesophageal tube misplacement. Patients undergoing ENT interventions at our hospital are routinely monitored by ECG, arterial blood pressure by cuff, capnography, and pulse oximetry. Beat-to-beat values of Sao2 and CO2 waveform were recorded by a graphic printer connected to a microcomputer, ASA I patients were routinely preventilated with FIO2 = 0.3, and ASA II-III patients with FIO2 = 1.0. ⋯ Oesophageal misplacement was detectable within 7.5 +/- 0.9 s in patients preventilated with FIO2 = 0.3 due to a 2.1 +/- 0.8% decrease in Sao2 (P less than 0.001). Our results underscore the significance of capnometry for rapid detection of inadvertent oesophageal intubation. High-resolution pulse oximetry is a valuable supplement but not a substitute for capnometry.
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Enteral nutrition is best delivered via a small bore feeding tube whose tip lies in the proximal jejunum. A major obstacle to tube placement is the lack of a reliable means of assuring passage through the pylorus. A simple, quick method of tube placement using endoscopic assistance that was successful in 18 of 20 (90%) attempts is described.
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NGT insertion is a procedure that is done frequently in Emergency Departments. A step-by-step procedure has been presented. There are certain circumstances that may make NGT insertion difficult. ⋯ Complications, although rare, may occur. Examples of complications that are reported in the literature include mucosal ulcerations, submucosal passage of a tube, accidental passage of an NGT into the brain, and esophageal perforation. Generous lubrication, direct visualization, and the use of fluoroscopy, as well as knowledge of these complications, may help to decrease or prevent their incidence.